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short and allow it to remain, and have never had a single bad result. Who would think, after ligating the pedicle of an ovarian tumor, of allowing the end of the ligature to hang out of the wound so it could be removed? I believe if you try this method you will like it.
A word concerning drainage-tubes. It may be the best treatment to use them in some cases, such as the removal of fluids from the deep cavities of the body, but certainly not from superficial cavities or wounds. My experience and observation have shown that their universal tendency is to produce fistula if they are long continued. If there is pent-up fluid it is better to give it a free outlet and to cleanse the cavity. There is about as much reason generally for the use of drainage-tubes as there is for setons. I can relate a numer of cases to substantiate this statement.
I need only mention the subject of varicose veins. The practitioner will call to mind a number of instances in the treatment of which he has been perplexed and worried, resorting to astringent applications, bandages, injections, acupressure, ligatures, etc.; and yet in the majority of cases the treatment has not been very satisfactory. We all know that it is not in many cases an easy thing to obliterate or premanently contract old chronic varicose veins. A majority of those occur upon the lower limbs, and when superficial the most satisfactory treatment I have found is to cut into the vein in a number of places-two, four or six inches apart, as the case requires. In this way you will effectually and permanently obliterate the vein, and with less danger of inflammation than by any other mode of proceeding. True, you will have some hemorrhage, but to no alarming extent. Slight pressure will generally arrest all hemorrhage.
When it comes to varicocele, or enlarged veins of the scrotum, this is the treatment, far superior to the ligature: Open the scrotum by incision; pick up or dissect up the veins
and cut them off. Wounds of the scrotum generally heal without trouble, and very kindly, particularly incised wounds. In this connection allow me to add my testimony to many others in favor of Thuja occidentalis as the injection for the radical cure of hydrocele after the fluid has been drawn from the tunica vaginalis. Inject through the canula one or two drachms of the Fluid Extract of Thuja. I have used it in numerous cases during the last few years, and some of them old chronic cases, and always with the happiest results. I never have used the second injection, except in one or two cases. Sometimes there has been a good deal of swelling and soreness, but that is of short duration. This injection is superior in every respect to iodine. Hydrate of chloral has been recommended, but I have not tried it.
A large percentage of the human family suffer from this painful and annoying disease of the rectum. For a physician to be successful in the treatment of hemorrhoids is to be assured of a lucrative practice. Patients generally have a horror of the use of the knife, and do not generally have so much dread of the ligature. There are but few who will not willingly submit to the hypodermic injection of a hemorrhoidal tumor if there is a reasonable prospect of permanent relief. The injection of carbolic acid with glycerine or olive oil has become so popular, and so widely known and extensively practiced, that many itinerant specialists have gained a reputation as pile-doctors, who know but little about the anatomical structure of the parts, and probably less concerning the nature of the agents used. I have used the carbolic acid and sweet oil as an injection in hemorrhoids in many cases; sometimes with seemingly good effect; but more often the treatment has been a failure and I have been compelled to resort to the ligature. This is my favorite method for removing hemorrhoidal tumors. I have been more successful, and, I believe, with less danger than by injections. Occasionally one dies from the effect of the injection; while the ligature is comparatively free from danger. From the best authenticated
statistics that I have seen there is less likelihood of a return where the ligature or knife has been used. The relief afforded by injections is often only temporary.
OPERATION FOR HERNIA.
Prominent among the operations in surgery recently devised stands that introduced for the radical cure of hernia. When we are informed by statistics that about one in every eight of the human family in this country are the subjects of hernia in some form, any treatment that looks toward the permanent alleviation and radical cure of this worrisome as well as dangerous condition will be hailed with gladness by the world of surgeons. In 1836 Prof. Pancoast, of Philadelphia, resorted to an astringent injection for this purpose, but did not long continue his experiments. More recently Dr. Spanton, of England, invented an instrument for bringing together the pillars of the inguinal ring, securing adhesions by means of mechanical irritation. What is known as the Heatonian method consists of an astringent and irritant injection, hypodermically introduced into the inguinal canal. The object is by adhesive inflammation to close the canal and rings and thus prevent the contents of the abdominal cavity from escaping through this abnormal channel. The Heatonian method has the advantage over Dr. Spanton's in this way: that there is no invaginated fascia which forms the plug the entire length of the canal; the patient need not be anæsthetised; there is no external opening and the patient need not be long confined in bed. There is not much pain in the after-treatment and no great danger of injury to important structures during the operation itself. Heaton used the fluid extract of Quercus alba. This preparation has been later improved upon by adding other remedies. The formula which I have used and is also used by others, is the following: R. fluid extract of Quercus alba zvj.—distilled down to ziij.; alcohol, zss.; sulphuric ether and tincture of Veratrum viride aa. zij.; morphine sulphate, grains. iv. A few drops, generally about ten, sometimes more, is hypodermically injected into the canal. A compress and bandage are then applied and the patient
required to keep quiet, in a recumbent position for a few days. In some chronic cases a second injection may be necessary, but generally one is sufficient. Out of twelve cases of which I have a record in only two was the second injection required. All made perfect recoveries. I would not be understood as saying that no skill or anatomical knowledge is required in making the application, but on the other hand it requires both. The needle should be of greater length than the ordinary hypodermic needle, larger and round-pointed, with the opening on the side a little from the point. From one to two weeks is the length of time the patient will generally be required to remain in bed. He will be able to dispense entirely with the use of a truss. Yet prudence would dictate that a truss be worn for a while afterward, as the adhesions are necessarily weak at first. The success with this method has been such as to give good reason for hope that few cases of hernia will be left outside the power of surgery to heal radically and permanently.
REPORT ON SURGICAL PROGRESS.
By L. E. RUSSELL, M. D., Springfield, Ohio, Secretary.
We live in a fast age. Progress everywhere stares us in the face. The surgical profession was never so busily engaged as it is at the present time; never so brilliant; never so full of bold experiments; never so beneficial in its results. Our best men are actively engaged in perfecting the knowledge of a surgical nature. False theories are giving way to facts, The knife is invading tissues that were once held sacred. Mysticism and old dogmas are shattered. In fact, the whole field of surgery is undergoing thorough revision.
We live in the noon-day of this wonderful and mighty progress. Surgical pathology was never more carefully and successfully reviewed. Topographical anatomy was never better understood. In London, Vienna, Berlin, Edinburgh, and our own land there is a masterly struggle for eminence in surgical attainments.
In 1851, the great physiologist, Helmholtz, invented the ophthalmoscope, and thus enables us to investigate diseases of the eye which were before utterly obscure. This instrument enabled Grufe to begin his, brilliant career; by it he worked out all the most difficult and complicated questions in ophthalmology.
Liebreich also devoted time and attention to the study and teachings of the ophthalmoscope; and the instrument also gives the precursory stages of other diseases, which, in their incipiency, are obscure and unrecognisable.
Joseph Clover, of London, years ago made a valuable contribution in surgical improvements by the invention of a double-current exhausting syringe, so useful in Lithotrity, and afterward improved by Dr. Bigelow, of Boston.
The mention of the name of Ephraim McDowell suggests the names of Thomas Keith, Spencer Wells, J. Marion Sims, Thomas Emmet, Robert Beatty, Walter Burnham and a host of mighty men. The name of Joseph Lister suggests cleanliness, and all that is neat and elegant in a surgical procedure. The name of Esmarch removes the terror of the timid surgeon and makes an otherwise hemorrhagic operation bloodless. The mention of the name of Prof. Billroth will cause the bold surgeon to convulsively clinch the knife and dare to invade the structure of almost any part of the living human body.
We find the names of great men associated with the different methods of surgical procedure, so that to mention a name is, in a word, to describe an operation.
Our worthy President, Prof. Howe, performed gastrotomy within the last year on a boy fifteen years of age, and with successful results. I quote the words of the worthy President:
"After administering chloroform to the remarkably calm patient, I made an incision five inches long in the course of the median line of the abdomen, leaving the umbilicus to the right. The wound was then carefully deepened till the abdominal parietes, including the lining of the peritoneum, were divided. Folds of normal-appearing intestines presented in the incised